Arch Hand Microsurg.  2021 Dec;26(4):303-308. 10.12790/ahm.21.0130.

Microsurgical Reconstruction of Lower Limb Using Thoracodorsal Artery Perforator Chimeric Free Flap after Popliteal Artery Revascularization: A Case Report

• Choi BH
• Chang LS
• Park SO
• Kim YH

• KMID: 2522630
• DOI: http://doi.org/10.12790/ahm.21.0130

Abstract

Although traumatic popliteal artery injury is uncommon, it can significantly increase the risk of limb amputation because of the anatomical complexity and delayed diagnosis and treatment. Various tools are available for treatment. Recently, an endovascular approach has been attempted for such injuries; however, open surgical repair remains the standard treatment. An integrated and stepwise procedure involving multidisciplinary specialists, including emergency department personnel for initial evaluation, orthopedic surgeons for treating accompanying fractures or dislocations, vascular and plastic surgeons for vessel repair, and interventional radiologists for immediate diagnosis and implementation of the endovascular approach, is needed. Covering wound defects due to skin and soft tissue necrosis and irreversible ischemic damage remains difficult despite successfully revascularizing the injured vessels. Here, we describe a case of revascularization after popliteal artery injury along with successful reconstruction of a complex defect with a thoracodorsal artery perforator chimeric free flap when recipient vessel selection was limited.

Keyword

Popliteal artery; Ischemia; Revascularization; Reconstructive surgical procedures; Free tissue flaps

Figure

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  Fig. 1. Posterior view of computed tomography angiography showing long segmental obstruction about 8 cm in length above the tibial plateau.

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  Fig. 2. The excised section of the allograft with an intravascular thrombus can be observed.

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  Fig. 3. Angiography was performed by a radiologist. (A) No occlusions were observed at the anastomosis site. (B) Diffuse vasospasm was observed at the proximal level of the lower extremity in all vessels, including the anterior tibial artery, peroneal artery, and posterior tibial artery.

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  Fig. 4. Magnetic resonance imaging revealed diffuse muscle necrosis and fatty degeneration below the knee level, especially involving the gastrocnemius and soleus muscles.

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  Fig. 5. (A) Image showing the dorsal ankle defect with exposure of the extensor tendon. (B) Posterior view of the heel defect with exposure of the calcaneus and Achilles tendon. (C) Lateral view of the heel defect. This heel defect was managed with periodic negative pressure wound therapy, and the fresh granulation tissue had grown into the wound.

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  Fig. 6. The harvested thoracodorsal artery perforator chimeric flap consisting of 6 × 7 cm-sized latissimus dorsi muscle and 16 × 12 cm-sized skin perforator flap.

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  Fig. 7. Immediate postoperative view. (A) A muscle flap was inserted into the dorsal ankle defect with a split-thickness skin graft. (B) Skin flap of the thoracodorsal artery perforator chimeric flap was incorporated into the heel defect area.

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  Fig. 8. (A) Anterior view, 6 months after the trauma. (B) Posterior view, 6 months after the trauma. No wound problems were observed, and independent walking was possible.

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